Individual
LACEY JACKSON LANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
907 18TH ST E, SUITE 150, TIFTON, GA 31794-3643
(229) 382-7120
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
GA
Other
Enumeration date
08/13/2014
Last updated
08/13/2014
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